Background

Accountable Care Units (ACUs) with Structured Interdisciplinary Bedside Rounds (SIBR rounds) are designed to improve the quality, safety, and efficiency of patient care in hospitals. These units and their processes directly support many of the Joint Commission's 2024 Hospital National Patient Safety Goals (NPSGs) by fostering better communication, teamwork, and patient engagement. Here's how they align with and support the specific goals:

1. Identify Patients Correctly (NPSG.01.01.01)

• In SIBR rounds, the entire care team, including doctors, nurses, pharmacists, and other healthcare professionals, meets at the patient's bedside. This allows for immediate and accurate verification of the patient’s identity by using at least two identifiers (e.g., name and date of birth) during each round. This reduces the risk of errors related to patient misidentification. During the ACU Change of Shift Huddle for nurses at each shift, the off-going nursing team alerts the in-coming team to any patients on the unit with similar names, to prevent mis-identification.

2. Improve Staff Communication (NPSG.02.03.01)

• SIBR rounds enhance communication among the interdisciplinary team members by ensuring that everyone involved in the patient's care is on the same page. This real-time exchange of information helps to promptly share important test results and updates, and emerging risks or non-response to treatment, ensuring that all team members have the most current information, which supports timely and effective decision-making.

3. Use Medicines Safely (NPSG.03.04.01, NPSG.03.05.01, NPSG.03.06.01)

• SIBR rounds provide an opportunity for the entire care team to review and verify medication orders, ensuring that all medicines are correctly labeled, especially before procedures. The team approach allows for a thorough review of the patient’s medication regimen, particularly for those taking high-risk medications like blood thinners, to prevent adverse drug events. Additionally, the rounds encourage patient involvement in discussing their medications, ensuring they understand their treatment plan and any changes that have been made.

4. Use Alarms Safely (NPSG.06.01.01)

• During SIBR rounds, the team can discuss and review the functioning of medical equipment alarms, ensuring that they are set appropriately and that the patient’s safety is monitored in real-time. The team’s presence on the unit and at the bedside helps ensure that alarms become more familiar with greater engagement and sense of responsibility to respond to alarms ensuring that they are not ignored or missed, as they are reviewed and acted upon promptly.

5. Prevent Infection (NPSG.07.01.01)

• During SIBR rounds all team members can emphasize the importance of hand hygiene and infection control practices. The presence of the entire care team at the bedside reinforces compliance with infection prevention protocols, such as hand cleaning according to CDC or WHO guidelines. The interdisciplinary nature of the rounds means that multiple professionals can monitor and remind each other to adhere to infection control practices. Furthermore, during step 4 of SIBR, the bedside nurse is responsible for updating the team on potential risk states associated with IV access or in-dwelling urinary catheters, or depending on the unit's patient population the presence of drips or drains, all of which may be at risk of emergent infections. Daily discussion of these risk states among the team, increases the frequency of communication about the necessity and rationale for prolonged use.

6. Identify Patient Safety Risks (NPSG.15.01.01)

• SIBR rounds facilitate the identification and discussion of patient safety risks, including the risk of suicide. By having the entire care team present, potential safety risks can be identified early, and interventions can be discussed and implemented immediately. This proactive approach to patient safety is crucial in mitigating risks.

7. Improve Health Care Equity (NPSG.16.01.01)

• SIBR rounds promote a team-based approach that is inclusive of all patients, regardless of their background. This model encourages the identification of disparities in care and ensures that all patients receive equitable treatment. The interdisciplinary nature of the rounds allows for a comprehensive understanding of each patient’s unique needs, leading to the development of personalized care plans that address disparities.

8. Prevent Mistakes in Surgery (UR01.01.01, UR01.02.01, UR01.03.01)

• For surgical patients, SIBR rounds offer an opportunity to double-check that all pre-surgical preparations are accurate. The care team can verify that the correct surgery is planned, that the correct site is marked, and that the patient and team are aligned on the procedure to be performed. The collaborative approach reduces the likelihood of surgical errors by ensuring that all steps are double-checked by multiple professionals. Nearly half of adverse events for surgical patients occur post-surgery. SIBR rounds create daily accountability moments within the care team to ensure that known and emergent risk states are being proactively addressed, with the plan of care and plan for discharge being discussed from day 1 post-op: deviations from these plans are readily identifiable by the team, who are meeting daily at the bedside during SIBR rounds.